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The great mask debate: Should we all be wearing them to prevent coronavirus?

Nancy Walthper stands for a portrait outside Safeway in Phoenix on April 4, 2020. Her mask is made from a wash cloth. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Nancy Walthper stands for a portrait outside Safeway in Phoenix on April 4, 2020. Her mask is made from a wash cloth.
Eli Imadali/The Republic

Terry, who preferred not to give a full name, stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn a respirator, which he typically uses for work, for the last week. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Terry, who preferred not to give a full name, stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn a respirator, which he typically uses for work, for the last week.
Eli Imadali/The Republic

Linda Hart stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her "summer gear" as a mask for a few days now. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Linda Hart stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her "summer gear" as a mask for a few days now.
Eli Imadali/The Republic

Dikeya Williams stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask, complete with a stapled on image of teeth with grillz and fangs, for two weeks and works as a child care director and provider. Eli Imadali, Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Dikeya Williams stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask, complete with a stapled on image of teeth with grillz and fangs, for two weeks and works as a child care director and provider.
Eli Imadali, Eli Imadali/The Republic

Rick Ridenhour stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's been wearing a mask for more than two weeks since he has underlying conditions. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Rick Ridenhour stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's been wearing a mask for more than two weeks since he has underlying conditions.
Eli Imadali/The Republic

Geno Waddell stands for a portrait outside Safeway in Phoenix on April 4, 2020. He bought the bandana-type piece for fashion a while back, but has now converted it into a mask. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Geno Waddell stands for a portrait outside Safeway in Phoenix on April 4, 2020. He bought the bandana-type piece for fashion a while back, but has now converted it into a mask.
Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Paul Rodriguez stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn his mask, a coveted 3M N95, for two weeks. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Paul Rodriguez stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn his mask, a coveted 3M N95, for two weeks.
Eli Imadali/The Republic

Carol Ramella stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask for three weeks. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Carol Ramella stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask for three weeks.
Eli Imadali/The Republic

Adriana Ramirez stands for a portrait outside Safeway in Phoenix on April 5, 2020. She just started wearing her homemade mask today. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Adriana Ramirez stands for a portrait outside Safeway in Phoenix on April 5, 2020. She just started wearing her homemade mask today.
Eli Imadali/The Republic

Matty Cruz stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn the mask for a week. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Matty Cruz stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn the mask for a week.
Eli Imadali/The Republic

Felipe Sanchez stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn a mask for three weeks now. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Felipe Sanchez stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn a mask for three weeks now.
Eli Imadali/The Republic

Leo Leon stands for a portrait outside Safeway in Phoenix on April 5, 2020. He started wearing a mask in public a month ago. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Leo Leon stands for a portrait outside Safeway in Phoenix on April 5, 2020. He started wearing a mask in public a month ago.
Eli Imadali/The Republic

Emily Spetrino stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask for about four days. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Emily Spetrino stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask for about four days.
Eli Imadali/The Republic

Iggy Spetrino, 12, stands for a portrait outside Safeway in Phoenix on April 5, 2020. His mother, Emily Spetrino, said this was his first day out of the house in a while. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Iggy Spetrino, 12, stands for a portrait outside Safeway in Phoenix on April 5, 2020. His mother, Emily Spetrino, said this was his first day out of the house in a while.
Eli Imadali/The Republic

George Rodriguez stands for a portrait outside Safeway in Phoenix on April 5, 2020. He started making masks, including this Batman one, and selling them on his Etsy site that he usually sells drag queen wigs on, Georgina the Doll Wigs. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

George Rodriguez stands for a portrait outside Safeway in Phoenix on April 5, 2020. He started making masks, including this Batman one, and selling them on his Etsy site that he usually sells drag queen wigs on, Georgina the Doll Wigs.
Eli Imadali/The Republic

Fidelia de Leon stands for a portrait outside Safeway in Phoenix on April 5, 2020. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Fidelia de Leon stands for a portrait outside Safeway in Phoenix on April 5, 2020.
Eli Imadali/The Republic

Nikka Jumalon stands for a portrait outside Safeway in Phoenix on April 5, 2020. She started wearing a mask in public a month ago. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Nikka Jumalon stands for a portrait outside Safeway in Phoenix on April 5, 2020. She started wearing a mask in public a month ago.
Eli Imadali/The Republic

Brendan Comstock stands for a portrait outside Safeway in Phoenix on April 5, 2020. Today was the first day he's worn the mask his sister made for him. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Brendan Comstock stands for a portrait outside Safeway in Phoenix on April 5, 2020. Today was the first day he's worn the mask his sister made for him.
Eli Imadali/The Republic

Barbra Spotts stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask for three weeks now since she works as an in-home counselor. In-home counselors like Spotts are now able to practice tele-counseling, however. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Barbra Spotts stands for a portrait outside Safeway in Phoenix on April 5, 2020. She's worn her mask for three weeks now since she works as an in-home counselor. In-home counselors like Spotts are now able to practice tele-counseling, however.
Eli Imadali/The Republic

John Ballard stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn a fishing gaiter as a mask for the last week. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

John Ballard stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's worn a fishing gaiter as a mask for the last week.
Eli Imadali/The Republic

Vivian Gordon stands for a portrait outside Safeway in Phoenix on April 5, 2020. She made her mask over the weekend. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Vivian Gordon stands for a portrait outside Safeway in Phoenix on April 5, 2020. She made her mask over the weekend.
Eli Imadali/The Republic

Kevin Thomas stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's been wearing his makeshift mask for about a week. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Kevin Thomas stands for a portrait outside Safeway in Phoenix on April 5, 2020. He's been wearing his makeshift mask for about a week.
Eli Imadali/The Republic

Maureen Young stands for a portrait outside Safeway in Phoenix on April 4, 2020. She made her mask this morning. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Maureen Young stands for a portrait outside Safeway in Phoenix on April 4, 2020. She made her mask this morning.
Eli Imadali/The Republic

Bill Sandweg stands for a portrait outside Safeway in Phoenix on April 4, 2020. He adapted his shemagh into a mask, which he's worn for three days. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Bill Sandweg stands for a portrait outside Safeway in Phoenix on April 4, 2020. He adapted his shemagh into a mask, which he's worn for three days.
Eli Imadali/The Republic

Patricia Kasper, 80, stands for a portrait outside Safeway in Phoenix on April 4, 2020. She started wearing the mask her daughter gave to her a few days ago. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Patricia Kasper, 80, stands for a portrait outside Safeway in Phoenix on April 4, 2020. She started wearing the mask her daughter gave to her a few days ago.
Eli Imadali/The Republic

Nicole Samuelson stands for a portrait outside Safeway in Phoenix on April 4, 2020. She's worn her mask for two weeks now. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Nicole Samuelson stands for a portrait outside Safeway in Phoenix on April 4, 2020. She's worn her mask for two weeks now.
Eli Imadali/The Republic

Jessie Gillie stands for a portrait outside Safeway in Phoenix on April 4, 2020. He's worn his mask for a couple days outside of his work as a nurse. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Jessie Gillie stands for a portrait outside Safeway in Phoenix on April 4, 2020. He's worn his mask for a couple days outside of his work as a nurse.
Eli Imadali/The Republic

Desi Stoyanova and her dog Lucy sit for a portrait outside Safeway in Phoenix on April 4, 2020. A friend gave her the homemade mask. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Desi Stoyanova and her dog Lucy sit for a portrait outside Safeway in Phoenix on April 4, 2020. A friend gave her the homemade mask.
Eli Imadali/The Republic

Stephanie Big Crow stands for a portrait outside Safeway in Phoenix on April 4, 2020. She's worn her mask for three weeks now. Big Crow said she was already prepared for survival because of her mistrust of the federal government as a Lakota woman. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Stephanie Big Crow stands for a portrait outside Safeway in Phoenix on April 4, 2020. She's worn her mask for three weeks now. Big Crow said she was already prepared for survival because of her mistrust of the federal government as a Lakota woman.
Eli Imadali/The Republic

Quinton Miranda stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was his first day of wearing the mask his friend made for him. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Quinton Miranda stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was his first day of wearing the mask his friend made for him.
Eli Imadali/The Republic

Chelsea Pote stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was her first day of wearing a mask outside of working as a nurse. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Chelsea Pote stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was her first day of wearing a mask outside of working as a nurse.
Eli Imadali/The Republic

Jose Rodriguez stands for a portrait outside Safeway in Phoenix on April 4, 2020. He's worn a mask for a few days now. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Jose Rodriguez stands for a portrait outside Safeway in Phoenix on April 4, 2020. He's worn a mask for a few days now.
Eli Imadali/The Republic

Recha Faulkner stands for a portrait outside Safeway in Phoenix on April 4, 2020. She started wearing her mask today. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Recha Faulkner stands for a portrait outside Safeway in Phoenix on April 4, 2020. She started wearing her mask today.
Eli Imadali/The Republic

Damien Plues stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was the first day he's worn his homemade mask. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Damien Plues stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was the first day he's worn his homemade mask.
Eli Imadali/The Republic

Jose Bernal stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was his first day of wearing the mask his friend made for him. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Jose Bernal stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was his first day of wearing the mask his friend made for him.
Eli Imadali/The Republic

Patricia Woodward stands for a portrait outside Safeway in Phoenix on April 4, 2020. It was her first time wearing her new mask. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Patricia Woodward stands for a portrait outside Safeway in Phoenix on April 4, 2020. It was her first time wearing her new mask.
Eli Imadali/The Republic

Iller Hardy stands for a portrait outside Safeway in Phoenix on April 4, 2020. It was her first day wearing a mask. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Iller Hardy stands for a portrait outside Safeway in Phoenix on April 4, 2020. It was her first day wearing a mask.
Eli Imadali/The Republic

Jason Payne stands for a portrait outside Safeway in Phoenix on April 4, 2020. He's been wearing his mask for a couple days. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Jason Payne stands for a portrait outside Safeway in Phoenix on April 4, 2020. He's been wearing his mask for a couple days.
Eli Imadali/The Republic

Laura Plues stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was the first day she's worn her homemade mask. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Laura Plues stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was the first day she's worn her homemade mask.
Eli Imadali/The Republic

Lindsey Johnston stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was her first day of wearing a mask outside of working as a nurse. Eli Imadali/The Republic

Phoenicians wear masks to protect against coronavirus

Lindsey Johnston stands for a portrait outside Safeway in Phoenix on April 4, 2020. Today was her first day of wearing a mask outside of working as a nurse.
Eli Imadali/The Republic

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At the beginning of the coronavirus pandemic — before it was called a pandemic — the advice from U.S. public health officials was clear: If you aren't sick, you don't need to wear a mask.

The national discussion about mask-wearing has since become more ambiguous. The public health advice remains the same, but critics say the guidance was wrong and confusing and may have encouraged mask-hoarding.

There's a #masks4all movement on social media that argues for universal mask-wearing amid the pandemic, with some proponents saying it shows community solidarity in the fight against coronavirus.

On Tuesday, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the White House coronavirus task force will be "seriously considering" broader recommendations on mask-wearing for the American public once there's an adequate supply for health care workers.

Also on Tuesday, health officials in California's Riverside County issued a recommendation that all county residents cover their nose and mouth for essential travel to doctor's appointments, grocery store and pharmacy visits. The face coverings do not need to be medical grade, the county said.

On Wednesday morning, U.S. Surgeon General Jerome Adams said the U.S. Centers for Disease Control and Prevention had been asked to review its guidance on wearing masks.

Some proponents of universal masks are citing the recent case of a choir in Washington state, where members appear to have contracted the virus through the air via an asymptomatic person or people. The Los Angeles Times reported this week that 45 of 60 members who showed up for one practice later tested positive for the new coronavirus. Two are dead. Eight attendees told the Times that no one was coughing or sneezing, and that they practiced social distancing.

In an article published Friday in Science Magazine, the director-general of the Chinese Center for Disease Control and Prevention said the biggest mistake Americans and many European countries are making in fighting the new coronavirus, which causes COVID-19, is that they aren't wearing masks.

Mask messaging is confusing

The issue is giving rise to public debate. There are still many health experts who maintain the public does not need to wear surgical masks, as people in some other countries like China do, and that in some cases, it could give people a false sense of security.

Some public health experts say wearing a face mask actually causes people to touch their face more, which is bad for spreading the virus.

"I'm on the side that the general public should not be wearing masks as a general rule," said microbiologist Kelly Reynolds, a professor at the University of Arizona's Mel and Enid Zuckerman College of Public Health. "The data just does not support that it's effective in a broad population."

One of the problems with having a universal mask-wearing public is that they could be wearing the mask for a prolonged period of time, Reynolds said, and increase rather than decrease their chances of getting exposed to the virus. The mask itself may become a virus-collecting source of infection.

"What they are actually doing is concentrating the virus on the mask over time," she said. "You could be exposing yourself inadvertently."

But the message to the public is confusing: You don't need a surgical mask, but health care workers do.

The reason for that is health care workers don't have the advantage of social distancing, said Dr. Rebecca Sunenshine, medical director of disease control for the Maricopa County Department of Public Health.

"We have health care workers out there on the front lines who need these masks to protect them while they have to stand right in front of people who are actively coughing and sneezing and very, very sick," she said.

"They have to care for them and they don't have the option of standing six feet away from them. And we would like to preserve those masks for health care workers. That is part of living in a community where the people who are at the highest risk of getting exposed need to have the protection."

If there was an unlimited supply of masks, Sunenshine said she personally would still not choose to wear one in public.

"My daughter, who has asthma — I would not have her wear a mask in public," Sunenshine said. "I don't think that the benefits outweigh the discomfort and the possibility that it would get contaminated. But that is my personal recommendation for myself and my family."

Seriously people- STOP BUYING MASKS!

They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! https://t.co/UxZRwxxKL9

'We should all wear masks whenever we're out in public'

The U.S. Centers for Disease Control and Prevention's recommendation on masks is to wear a face mask if you are sick when you are around other people. If you are not sick, the CDC says a face mask is only needed if you are caring for someone who is sick and they are not able to wear a face mask.

"Face masks may be in short supply and they should be saved for caregivers," the CDC advice says.

Critics are starting to question that guidance, saying public health recommendations should not be taking mask supply into account.

An opinion column published March 28 in the Washington Post by University of San Francisco research scientist Jeremy Howard has become a talking point on television news shows and in print publications across the country. Howard argues that public health advice against mask-wearing was a policy misstep that needs a course correction.

"Masks effective at 'flattening the curve' can be made at home with nothing more than a T-shirt and a pair of scissors," he wrote. "We should all wear masks — store-bought or homemade — whenever we’re out in public."

In an email exchange with The Arizona Republic, Howard said the feedback he's been getting since Saturday has been "98% supportive." Some doctors have suggested that the science is unclear, but Howard disputes that claim. The science is clear, said Howard, who is the founding researcher at fast.ai, a data-focused research institute.

His Washington Post piece says he found 34 scientific papers indicating basic masks can be effective in reducing virus transmission in public. He also said he found not a single paper that shows clear evidence that they cannot.

Get the scientific evidence, quotes from experts, DIY recipes for homemade masks, media coverage, and everything you need to know about why we should all make a mask, and wear it when in public.https://t.co/uU7KhtLgKt

Mask wearing 101: Donning and doffing is important

Saskia Popescu, a senior infection prevention epidemiologist at George Mason University, says DIY masks offer some "quite limited" protection, but they are easily soiled and need constant cleaning. She has found the literature on community-wide mask usage also limited, with both pros and cons.

"Surgical masks are not perfect in that they don’t fully seal around the face and are only one piece to infection prevention efforts," she wrote in an email. "Most people don’t realize how easy it is to cross-contaminate when wearing a mask and frankly, wear them incorrectly. "

She also said universal mask-wearing could lead sick people to think a mask is acceptable protection.

"You should be staying home if you’re sick," she wrote.

Reynolds, the UA microbiologist, says if the public did wear masks they'd need to be educated in how to put them on and take them off — a process that in the health world is called "donning" and "doffing."

"I haven't done studies with the general public. But I have done studies with health care workers. They don't always take the masks off properly," she said.

"About 30% of the people we worked with were making mistakes with their PPE (personal protective equipment). That could be gloves or masks or gowns. Overall, we saw mistakes where they touched the mask in a place that could contaminate their hands."

When "doffing" surgical mask, it's important to use the elastic straps without ever touching the front of the mask, Reynolds said. Even some health care workers, she said, have a habit of just grabbing the mask from the front, pulling it away from their face and stretching it over their head, which could contaminate their hands with what might have concentrated on the mask.

"It could also, in the action of moving the mask around, aerosolize the viruses that were concentrated on the mask and expose you even more," she said. "We see so many mistakes with people who are even trained to do this."

No-mask message is 'deeply counterproductive,' critic says

The #masks4all proponents such as Howard emphasize that masks are not a substitution for good hand hygiene, isolation, quarantine, contact tracing and social distancing.

But he says the argument that the public could inadvertently contaminate their mask is "spurious" because it's better for the mask to be contaminated than the person wearing it.

Telling people they won't know how to properly wear a mask "isn't a winning message" and is "deeply counterproductive," Zeynep Tufekci, a University of North Carolina associate professor of information science, wrote in a March 17 New York Times op-ed.

"Many people also wash their hands wrong, but we don’t respond to that by telling them not to bother. Instead, we provide instructions; we post signs in bathrooms; we help people sing songs that time their hand-washing," she wrote.

Tufekci said that messaging about the scarcity of masks and the need to preserve them for health care workers may have led members of the public to hoard them.

As for Howard's advice that a T-shirt or bandana could be used to make a mask, a point that he made in his Washington Post column, the UA's Reynolds is skeptical.

"Now we have a mask that is not designed to remove anything in particular," she said. "For somebody to select that now, when you are not even being exposed to a patient, that makes no sense to me. If you social distance, you will avoid the large droplet exposures much better than if you wear any kind of mask."

Sunenshine of the Maricopa County Department of Public Health said she always has been transparent about why it's not recommended that members of the general public wear masks unless they are sick or caring for someone in their home who is sick and can't wear a mask.

Remembered

'Paying tribute to Arizona victims of COVID-19

First, it can cause more harm than good, she said, and, second, it could take away resources from health care workers who need them.

Sunenshine said she's not an expert in homemade masks yet understands that for some people, it could help lower anxiety, and that could be helpful. The wearer needs to be aware the mask could get contaminated, she said.

Some other reminders for the wearer of a homemade mask: It needs to be made in a way that prevents secretions from getting inside, it needs to be washed regularly, and the wearer should be mindful about not touching the mask. If they do touch the mask, they need to wash their hands, she said.

If you do not have any respiratory symptoms, such as fever, cough, or runny nose, you do not need to wear a medical mask. When used alone, masks can give you a false feeling of protection and can even be a source of infection when not used correctly. ➡️https://t.co/0nyHux1SgNpic.twitter.com/JDQhnowx3p